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Purpose: To describe the emerging evidence concerning etiologic factors and pathophysiologic mechanisms involved in peri-implant inflammatory diseases. Materials and Methods: An electronic search for articles published until November 2022 was conducted in MEDLINE by three independent reviewers to identify the manuscripts' reporting data on etiologic factors and pathophysiologic mechanisms associated with peri-implant diseases. Results: Current evidence suggests that peri-implant mucositis and peri-implantitis are inflammatory conditions linked to a microbial challenge. However, in recent years there has been increasing evidence indicating that certain peri-implant inflammatory conditions may not be primarily related to biofilm-mediated infectious processes but rather to other biologic mechanisms, such as a foreign body response. Conclusions: Current evidence in the dental and medical literature opens new avenues for a more complex interpretation of the etiopathogenetic factors involved in peri-implant diseases. A better understanding of various factors related to the host response, including dysbiosis mechanisms associated with changes in microbiota composition, is necessary for a more precise physiopathologic characterization of these diseases. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the influence of abutment height (AH) on marginal bone loss (MBL). Materials and Methods: A literature search was performed for human studies (RCTs, prospective and retrospective cohorts) reporting on AH and MBL. The data obtained--including clinical outcomes, treatment covariates, and patient characteristics--were analyzed. Meta-regression was performed on the effect size of the differences between the shorter and larger AHs on the MBL of each study. The estimation was done using the restricted maximum likelihood method. Results: The initial screening and full-text analysis resulted in 7,936 and 46 articles, respectively. Finally, 14 articles were included in the systematic review, reporting a total of 1,606 implants. An overall high-to-moderate risk of bias was determined among the included investigations. Meta-regression analysis revealed that AH had a significant effect on MBL (b = --1.630, P < .003), demonstrating that longer abutments were correlated with less MBL. No effects were observed for the study type (P = .607), the number of stages (P = .510), or the elapsed time (P = .491). Conclusions: The height of the abutment has a significant impact on MBL. As such, increased AH is related to less MBL. Nevertheless, the role of confounding variables remains to be studied and determined. [ABSTRACT FROM AUTHOR]

Purpose: To determine clinical parameters, histologic features, and radiographic linear bone width changes of regenerated bone using different biomaterials for ridge preservation following tooth extraction. Materials and Methods: For this pilot study, five patients were grafted with anorganic bovine bone and collagen plus recombinant human platelet-derived growth factor-BB (rhPDGF-BB), five patients were grafted with anorganic bovine bone and collagen alone, and five patients did not receive any biomaterial (control) after tooth extraction. Clinical, histologic, and radiographic evaluations were carried out 4 months postextraction. Results: Differences in terms of buccolingual width were found when comparing the control group to the group grafted with anorganic bovine bone and collagen plus rhPDGF-BB (P = .012). No statistical differences were observed between the groups in terms of mineralized or nonmineralized tissue formation or in terms of the number of osteoblasts or osteocytes per mm2 after 4 months of healing. Interestingly, the number of vessels in the grafted area was found to be significantly different among the three groups (P = .005). The number of Musashi-1 positive cells was also different among groups, both in the mineralized and the nonmineralized areas of the grafted bone (P = .024 and .005, respectively). Conclusion: Anorganic bovine bone with bovine collagen is an efficient biomaterial to avoid postextraction resorption of the alveolar ridge. The addition of rhPDGF-BB appears to improve the biologic features of the newly formed bone and decrease bone resorption; further studies are needed for confirmation. [ABSTRACT FROM AUTHOR]

Purpose: To compare implant survival, marginal bone loss, peri-implant clinical parameters, and complications in dental implants placed in the posterior maxilla in native bone or after grafting using the open sinus lift technique. Materials and Methods: A search was made of two electronic databases (MEDLINE via PubMed and the Cochrane Oral Health Group Trials Register [CENTRAL]), complemented by a manual search. The study included randomized clinical trials, non-randomized clinical trials, and observational studies such as cohort studies and case-control studies conducted on a prospective or retrospective basis and comparing the placement of standard-length implants (≥ 10 mm) in native bone or after grafting using the sinus lift procedure. Risk of bias was evaluated with the Cochrane risk of bias assessment tool and the methodological index for non-randomized studies (MINORS). Results: The search yielded 51 studies, of which 23 were included. Two studies were evaluated with the Cochrane risk of bias assessment tool, with neither being identified as presenting a low risk of bias. Twenty-one studies were evaluated by the MINORS, yielding a mean score of 15.76 points out of 24. The implant survival rate in the control group was 90% to 100% versus 75.3% to 100% in the test group over a follow-up period of 6 to 120 months. Most studies revealed no statistically significant differences. In most of the publications, marginal bone loss was greater in the test group than in the control group, though without reaching statistical significance. Similar results were obtained in both groups with regard to the peri-implant clinical parameters. There were more surgical complications in the test group than in the control group--such complications being inherent to the sinus lift procedure. Conclusion: Implant placement after sinus lift affords results in terms of implant survival, marginal bone loss, and peri-implant clinical parameters similar to those obtained with conventional implant placement in native bone. However, there is a greater incidence of surgical complications associated with the sinus lift procedure. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective study quantitatively analyzed the minimum prosthetic abutment height to eliminate bone loss after 4.7-mm-diameter implant placement in maxillary bone and how grafting techniques can affect the marginal bone loss in implants placed in maxillary areas. Materials and Methods: Two different implant types with a similar neck design were singularly placed in two groups of patients: the test group, with platformswitched implants, and the control group, with conventional (non-platform-switched) implants. Patients requiring bone augmentation underwent unilateral sinus augmentation using a transcrestal technique with mineralized xenograft. Radiographs were taken immediately after implant placement, after delivery of the prosthetic restoration, and after 12 months of loading. Results: The average mesial and distal marginal bone loss of the control group (25 patients) was significantly more than twice that of the test group (26 patients), while their average abutment height was similar. Linear regression analysis highlighted a statistically significant inverse relationship between marginal bone loss and abutment height in both groups; however, the intercept of the regression line, both mesially and distally, was 50% lower for the test group than for the control group. The marginal bone loss was annulled with an abutment height of 2.5 mm for the test group and 3.0 mm for the control group. No statistically significant differences were found regarding marginal bone loss of implants placed in native maxillary bone compared with those placed in the grafted areas. Conclusion: The results suggest that the shorter the abutment height, the greater the marginal bone loss in cement-retained prostheses. Abutment height showed a greater influence in platform-switched than in non-platform-switched implants on the limitation of marginal bone loss. [ABSTRACT FROM AUTHOR]

Purpose: To examine differences in morphology and in immunophenotype subsets between chronic periodontitis (CP) and peri-implantitis (P-I) lesions and to test the diagnostic agreement (CP vs P-I) among three independent observers, based on histopathological features. Materials and methods: This observational cross-sectional study included 15 gingival biopsies of CP lesions and 15 biopsies of P-I lesions for double-blinded examination by three independent pathologists. Inflammatory infiltrate intensity was assessed semiquantitatively on a 4-point scale, determining the percentage of lymphocytes, plasma cells, monocytes/macrophages, and granulocytes and the presence/absence of bacterial colonies. Immunohistochemical analyses were performed to verify the inflammatory infiltrate subset data (CD45, CD38, CD68 and myeloperoxidase [MPO]-positive), and number of vessels. Kappa statistic was used to evaluate the degree of diagnostic concordance among examiners. Results: Inflammatory infiltrate was significantly more severe in P-I cases (P = 0.01), which showed a significantly higher percentage of plasma cells (P = 0.004) than in CP cases. Immunohistochemically, the percentage of leukocyte subsets was generally lower in CP (CD38: 32.05%; CD68: 6.45% and MPO: 8.62%) than in P-I (CD38: 61.13%; CD68: 9.09% and MPO: 7.47%) (CD38 P = 0.001, P = 0.955 and P = 0.463, for remaining subsets, respectively; Mann-Whitney U-test). The interobserver diagnostic agreement was poor or slight (kappa = -0.18 to 0.13). Conclusions: Despite the significantly more severe general inflammatory infiltrate and plasma cells in P-I cases, it proved difficult to detect reliable differential morphological features based on histopathological images of these CP and P-I soft-tissue samples, obtaining low inter-observer and intraobserver diagnostic agreement. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of titanium (Ti) particles on oral epithelial cell homeostasis and the potential of dental implants to release Ti debris upon insertion. Materials and Methods: Dental implants with varying surface treatments were employed to determine the feasibility of particle release during implant placement as well as the impact of free Ti debris on oral epithelial cells. Ti particles derived from implant surfaces were isolated and cultured in direct contact with normal oral epithelial cells for 48 hours. Further, cells were fixed and processed for immunofluorescence assay to detect the activation of the DNA damage response (DDR) using CHK2 and BRCA1 molecular markers. Positive cells demonstrating DNA damage were quantified and statistically analyzed. Results: Ti particles derived from implants containing phosphate-enriched titanium oxide (PETO), fluoride-modified (FM), and grit-blasted (GB) surface treatments were able to activate CHK2 and trigger the recruitment of BRCA1 in oral epithelial cells. Also, implants with GB surfaces were able to release Ti particles upon implant placement. Conclusion: The results indicate that Ti debris may be detached from the implant surface upon placement. Also, free Ti particles can trigger DDR signaling in oral epithelial cells. These findings suggest that Ti particles/debris released into a surgical wound may contribute to the disruption of epithelial homeostasis, and potentially compromise the oral epithelial barrier. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to systematically evaluate the marginal bone loss (MBL), success, and survival of zirconia (Zi) implants and compare them with the widely studied titanium (Ti) implants. Materials and Methods: An electronic and manual literature search of several databases was performed by two independent reviewers for articles up to July 2015 that reported the use of Zi implants and survival, success, and MBL with at least 12 months’ follow-up. In addition, random effects meta-analyses of selected studies were applied to analyze the weighted mean difference of survival, success, and MBL between groups. Meta-regression analysis was conducted to investigate any potential influence of confounding factors. Results: Twenty-one articles were included, analyzing a total of 1,948 Zi implants with a survival rate of 91.5% and a success rate of 91.6% for 1,250 Zi implants. In addition, three studies were included in the quantitative synthesis and were meta-analyzed for the comparison of survival between Zi and Ti implants, with Zi implants having an 89% greater risk of failure compared with Ti implants (OR = 1.89). There were no statistically significant differences (P = .968) in the success of Zi and Ti implants (odds ratio [OR] = 1.02; 95% confidence interval [CI], 0.47–2.20). MBL (± SD) for Zi implants was 0.89 ± 0.18 mm, which was greater than the MBL for Ti implants (mean difference = 0.14 mm). Also, survival of Zi implants (91.5%) was significantly lower than that of Ti implants (OR = 1.89). Meta-regression analysis revealed a similar survival rate for one-piece versus two-piece implants. Similarly, no significant differences were found between immediate and delayed loading. Conclusions: The survival rate of Zi implants was significantly lower than that for the commonly used Ti implants. However, for certain clinical conditions, such as a thin tissue biotype or in the highly esthetic anterior area, Zi implants may offer some benefit when compared with Ti implants. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the influence of posterior mandibular dimensions (height and width at various levels) on alveolar bone microarchitecture using microcomputed tomography (micro- CT). Materials and Methods: Partially edentulous subjects with one missing molar were included in the study. A bone core biopsy was performed at the site of planned implant surgery. For each patient, alveolar morphologic and architectural characteristics were analyzed using cone beam computed tomography (CBCT) and micro-CT imaging. Two parameters for height (apicocoronal residual height [RH] and residual ridge from inferior alveolar canal [RHN]) and three for buccolingual width (residual width at 5 mm [RW1], at 10 mm [RW2], and at 15 mm [RW3]) were determined using CBCT. Additionally, 10 parameters were obtained from micro-CT to determine microarchitecture. Pearson product-moment correlation coefficients were calculated to examine the correlation between the morphologic and microarchitectural variables. Results: Significant positive correlations (P < .05) were found between RH and bone volumetric fraction (BV/TV) (rs = 0.34) and trabecular thickness (Tb.Th) (rs = 0.45). A significant negative correlation was found between RH and the bone-specific surface (BS/BV) (rs = -0.34). A strong significant negative correlation was found between trabecular spacing (Tb.Sp) and RW1 (rs = -0.42). None of the other variables reached statistical significance. Conclusion: Posterior mandibular dimensions may affect bony architectural characteristics. [ABSTRACT FROM AUTHOR]

Purpose: To systematically appraise the effectiveness/reliability of vertical ridge augmentation (VRA) in the atrophic mandible. Articles that addressed any one of the following four areas were included in this study: amount of VRA, implant survival (ISR) and success rates (SSR) in the area of newly regenerated bone, complication rate during the bone augmentation procedure, and bone resorption. Materials and Methods: An electronic literature search was conducted by two independent reviewers in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases for articles reporting VRA in the atrophic mandible via distraction osteogenesis (DO), inlay block grafting (IBG), onlay block grafting (OBG), and guided bone regeneration (GBR). For meta-analysis, two primary (VRA and ISR [%]) and two secondary outcomes were studied (SSR [%] and vertical bone resorption [VBR] [%}). Additionally, for qualitative assessment, complications (ie, causes of failure) were further extracted and comprehensively described. Results: Overall, 73 full-text papers were evaluated. Of these, 52 articles fulfilled the inclusion criteria. The weight mean (WM) of VRA (± SD) was 4.49 ± 0.33 mm (95% CI: 3.85 to 5.14 mm). It was most notable that DO involved greater VRA than IBG, and thus, significantly higher than GBR and OBG. The technique significantly influenced the mean VRA obtained (P < .001). Nonetheless, no technique showed superiority in terms of ISR or SSR. VBR and complications were shown to be minimized for GBR. Conclusion: If ~ 4 mm of VRA is needed, any technique in optimum local and systemic conditions should be equally reliable in the atrophic mandible. However, when greater VRA is needed, DO and IBG have demonstrated accuracy. By means of complication and VBR rates, GBR was shown to have the lowest. For ISR and SSR, no statistical differences existed among all techniques. Controlled studies are needed to examine the long-term peri-implant bone fate and the frequency of biologic complications in each technique applied for the vertical augmentation of the atrophied mandible. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare solvent dehydrated human allograft (SDHA; Puros Allograft) and freeze-dried human allograft (FDHA; MinerOss) in order to determine if the allogeneic bone preservation process influences the amount of remaining particles and newly formed bone in maxillary sinus augmentation. Materials and Methods: Subjects requiring maxillary lateral sinus augmentation with ridge height < 5 mm were included in this study. Maxillary sinuses were randomly assigned to be grafted with a 1:1 ratio of cortical and cancellous bone, either SDHA or FDHA. In both groups, the graft material was mixed with autogenous bone graft at a ratio of 1:1. Morphologic and histomorphometric analyses were completed 6 months after the grafting procedure. Results: Thirty-four subjects were included in this study. All subjects showed similar demographic characteristics at baseline. Half of the sinuses were grafted with SDHA; the remaining half were grafted with FDHA. Histomorphometric analysis of bone core biopsy samples showed no statistically significant difference between the SDHA or FDHA allogeneic bone substitutes (P = .365), with a mean value of 39.54% ± 0.05% and 31.96% ± 0.08% of mineralized tissue for SDHA and FDHA, respectively. However, a slightly higher mean value of remaining particles was obtained for the FDHA compared with SDHA (18.91% ± 0.09% vs 8.65% ± 0.06%, respectively), although the difference was not statistically significant. Additionally, FDHA demonstrated statistically significantly higher osteoblast, fibroblast, and inflammatory cell numbers. Conclusion: Regardless of the preservation process subtype, allogeneic bone grafting material, in combination with autogenous bone, was demonstrated to be effective for maxillary sinus augmentation bone by means of cellular, vascular, and histomorphometric behavior. Nonetheless, FDHA demonstrated higher cellularity compared to SDHA, suggesting accelerated turnover activity for the latter grafting material. [ABSTRACT FROM AUTHOR]

Maxillary sinus membrane perforation has been reported as the most common intraoperative complication during sinus augmentation, potentially leading to postoperative infection and consequent loss of graft or even implant failure. Numerous anatomical factors have been demonstrated to affect membrane tearing. However, careful use of proper instrumentation, such as a reamer, seems to play an important role in minimizing the incidence of these complications. Hence, the aim of the present study was to (1) investigate the reliability of reamer drilling for lateral window preparation; (2) examine the incidence of membrane perforation; and (3) study the factors that might influence membrane perforation. Results from this study showed the safety and effectiveness of using a reamer to perform lateral window approach sinus augmentation. The sinus membrane perforation rate was found to be 12.5%. A slightly higher perforation rate was noted in thinner maxillary lateral walls (< 1.25 mm). The authors concluded that reamer drilling is a safe and effective alternate technique for opening the lateral window wall when the lateral wall thickness is ≥ 1.25mm. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate marginal bone loss 6 and 12 months after prosthetic loading of implants with Dynamic Bone Management (Straumann, Basel, Switzerland) through the implementation of different drilling protocols. Materials and methods: A balanced, randomised, single-blind clinical trial was conducted with four parallel experimental arms: immediate loading and under-drilling, immediate loading and complete drilling, early loading and under-drilling, and early loading and complete drilling. Fortyfour implants with a Dynamic Bone Management design and with a diameter of 3.75 mm and a length of 10.00 mm were placed in healed mature bone (more than 6 months post-extraction). Results: The mean primary stability achieved was 60.6 ± 12.2 implant stability quotient, with a range from 21 to 75, and no differences were observed when considering the drilling protocol used, bone type or location. Early loading resulted in a loss of 0.728 mm (standard error 0.212; 95% confidence interval 1.134 to -0.325; t value -3.440), whereas immediate loading did not result in any bone loss. When the interaction between the loading and drilling protocols was studied, performing the complete drilling protocol in conjunction with early implant loading was found to result in lower marginal bone loss, with a marginal bone gain effect of 0.814 mm (standard error 0.283; 95% confidence interval -0.274 to 1.353; t value 2.880). Conclusions: Use of the complete drilling protocol in conjunction with early implant loading resulted in the lowest marginal bone loss at 12 months. [ABSTRACT FROM AUTHOR]

Purpose: Short- or long-term implant survival and success are related to peri-implant marginal bone loss (MBL), among other key factors. The purpose of this study was to analyze the role of clinical and implant-related variables in MBL over a long-term follow-up. Materials and Methods: A retrospective study of 558 implants in 172 patients was conducted, analyzing the relationship between MBL and clinical, implant-related, and prosthetic design-related variables. MBL was measured on digital radiographs with specific software, using implant threads as reference. Results: Linear mixed analysis revealed the following significant effects: a lower mean MBL for type IV bone (0.047 mm/year, 95% Cl [-0.019, 0.119]) than for type III bone (0.086 mm/year, 95% Cl [0.038, 0.138]), type II bone (0.112 mm/year, 95% Cl [0.070, 0.167]), or type I bone (0.138 mm/year, 95% Cl [0.052, 0.23]); an increased MBL of 0.033 mm/year for each increment of 1 mm in diameter (95% Cl [0.002, 0.065]); a lower mean MBL in smooth implants (0.103 mm/year, 95% Cl [0.090, 0.117]) vs rough implants (0.122 mm/year, 95% Ci [0.102, 0.142]). The mean MBL was > 0 mm/year for all prostheses except for fixed complete dental prostheses. Conclusion: Within the limits of a retrospective follow-up study, a lower mean peri-implant MBL was associated with type IV bone, a smaller diameter, a smooth surface, and a fixed complete dental prosthesis. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to analyze cone beam computed tomography (CBCT) densitometries of maxillary sinuses augmented with human bone allograft. In addition, previously obtained microradiographic specimens were used to verify the diagnostic potential of CBCT. Materials and Methods: A two-stage protocol was conducted in 21 consecutive patients, all with a crestal bone height < 2 mm. Mineralized human bone allograft particles were used to augment sinuses using a lateral window approach. A succession of CBCT scans of the maxilla were taken before surgery, immediately after sinus augmentation, and 6,10, and 18 months after implant placement. Using virtual probes, CBCT images taken at 6, 8, and 10 mm from the crestal surface were processed with medical imaging software and expressed as gray level (GL). Results: A total of 24 sinus augmentation procedures were performed in 21 patients. The average values of CBCT-GL ranged from 571 to 654, presenting the maximum value at 8 mm immediately after implant placement and the minimum value at 6 mm after 10 months. Furthermore, it was found that the graft mineral content decreased over time, completely disappearing between 10 and 11 months. Conclusion: CBCT and the medical imaging software employed for imaging visualization are reliable tools to study biomaterial behavior after sinus augmentation procedures. In addition, results from this study demonstrate that a complete resorption of human bone allograft is possible. Due to the limited sample size, further clinical and morphometric studies are needed. [ABSTRACT FROM AUTHOR]

Although some systemic conditions have been associated with peri-implant disease, local contributing factors largely remain to be determined. This study aimed at evaluating, based on clinical photographs obtained from peri-implantitis treatment publications, the possible local contributing factors involved in its development based upon a survey obtained from three experienced clinicians (> 20 years of expertise). Cohen's kappa index was used to test the interexaminer reliability. "Too-buccal implant position" was the only parameter to reach almost perfect interexaminer agreement (κ = 0.81). "Thin-tissue biotype" and "minimal presence of keratinized mucosa" demonstrated moderate agreement (κ = 0.43 and κ = 0.58, respectively). The rest of the parameters studied based on clinical photographs were fair or poor. Therefore, based on this clinicians' survey, implants too buccally placed, minimal or a lack of keratinized mucosa, and thin-tissue biotype might contribute to a higher susceptibility of developing peri-implantitis. These factors must be the focus of attention in future cross-sectional studies on the incidence of peri-implant diseases. [ABSTRACT FROM AUTHOR]

Purpose: For patients with narrow, single-tooth edentulous ridges as a result of permanent tooth agenesis (hypodontia) in the maxillary lateral and mandibular incisor regions, dental implant treatment may present a reliable and predictable restorative treatment solution. The aim of the present study was to evaluate the clinical reliability and outcome of small-diameter dental implants placed in a one-stage procedure with early loading replacing maxillary lateral or mandibular incisor teeth.Materials and Methods: Patients with hypodontia in the maxillary lateral incisor or mandibular incisor region analyzed in this report were selected from a larger prospective multicenter study. Small-diameter dental implants (AstraTech OsseoSpeed TX 3.0 S, Dentsply) of different lengths were placed using a one-stage surgical protocol with a 6- to 10-week healing period before loading. Probing pocket depth, bleeding on probing, and gingival zenith score were assessed after 6, 12, 24, and 36 months. Radiographic examination was assessed at 6, 12, and 36 months.Results: In total, 38 patients were included in this analysis and 62 small-diameter implants were placed. The mean distance between adjacent teeth was 6.30 mm (SD: 1.36). All patients received a titanium transmucosal abutment and cement-retained ceramic crown after 6 to 10 weeks of healing. Two implants were lost during the healing period before loading, providing a total implant survival rate of 96.8%. No implant fractures were reported. Mean marginal bone level change from surgery to follow-up visits at 6, 12, and 36 months were 0.39 mm, 0.22 mm, and 0.23 mm, respectively. The condition of soft tissue was stable at all follow-up visits with clinically insignificant changes in probing depth, bleeding on probing, and gingival zenith score.Conclusion: This study evaluated the behavior over 36 months of AstraTech Osseospeed TX 3.0 S dental implants placed into narrow one-tooth defect edentulous ridges as a result of hypodontia. The data collected highlighted the stability of the marginal bone level and soft tissues around the dental implants in conjunction with durable mechanical function. Small-diameter implants can be considered a valid solution in the restorative treatment of hypodontia in the maxillary lateral and mandibular incisor regions. [ABSTRACT FROM AUTHOR]

Purpose: Sinus floor elevation via the lateral window approach represents a reliable technique for augmenting bone volume in the atrophic posterior maxilla. However, controversy remains regarding the effect of placement of a barrier membrane over the lateral window. This histomorphometric meta-analysis sought to clarify the effect of barrier membranes in lateral window sinus augmentation. Materials and Methods: An electronic search of three databases and a hand search in implant-related journals for studies published through January 2013 in the English language was conducted. Randomized controlled trials, prospective human clinical studies, retrospective investigations, and case series reporting histomorphometric results after sinus elevation using the lateral window approach with at least six patients and a minimum follow-up period of 6 months were included. Results: The initial search yielded 1,040 articles, of which 94 were further evaluated for eligibility. Finally, 37 studies were chosen and separated into membrane (group 1) and no-membrane (group 2) groups. Similar vital bone formation was found in both groups: 32.36% for group 1 and 33.07% for group 2. Conclusion: Based upon this meta-analysis, the presence of a barrier membrane over the window does not influence the amount of vital bone formation after sinus augmentation. Additionally, the type of grafting material used and healing time did not influence the histomorphometric outcome. [ABSTRACT FROM AUTHOR]

Purpose: Control over marginal bone loss (MBL) and its progression is critical for preserving peri-implant tissue health. A moderate MBL over the first year has conventionally been associated with clinical success. However, different implants are associated with distinct amounts of MBL during their first functional year. Therefore, this study evaluated the MBL in pristine maxillary bone around implants with different types of implant-abutment connections and sought to determine the effect of other clinical factors on this tissue response. Materials and Methods: Two hundred forty-six implants were placed in 101 patients with a mean age of 54.43 years. The MBL around two different types of implants (internal versus external prosthetic connection) was evaluated at 6 and 18 months after loading. Different variables were recorded to analyze their influence on radiographic parameters using a complex samples general linear model. Results: At 18 months, MBL ranged from 0 to 3.56 mm; less than 1 mm was lost around 46.3% (mesial) and 40.2% (distal) of the implants, while no bone was lost around 19.5% (mesial) and 19.9% (distal). The MBL was significantly higher around external than internal connections (0.714 vs 0.516 mm/year, respectively). Age, smoking habit, and connection type were directly related to mesial and distal MBL at 6 and 18 months postloading. Conclusion: Implant design is a key factor in peri-implant MBL. Age and smoking also play major roles in maintaining the stability of peri-implant bone. [ABSTRACT FROM AUTHOR]

Purpose: There is limited evidence available on the influence of location on bone density in the maxilla. Therefore, this study was aimed at comparing the microarchitecture of bone harvested from different nonatrophic maxillary locations. Materials and Methods: A total of 37 partially edentulous subjects (aged 48.15 ± 15.85 years) were included in the study. A bone core biopsy specimen was obtained from one site per patient at the planned implant surgery location. Thirty-four specimens were used for microcomputed tomography (micro-CT) analysis. Mann-Whitney U tests (independent samples) were performed to determine whether the distributions of the six bone-related parameters showed significant differences between sexes and site locations. Study sites were categorized as either anterior (incisors and canines) or posterior (premolars and molars). The possible associations among variables (bone volume fraction [BV/TV], age, and five bone-related parameters) were examined using the Spearman rank correlation test. Results: The mean BV/TV values showed no significant difference between the maxillary anterior (46.93 ± 26.2) and posterior (51.90 ± 28.42) locations. Statistically significant positive correlations were identified between BV/TV and trabecular thickness (Tb.Th) (r = 0.6, P < .001) and between BV/TV and trabecular number (Tb.N) (r = 0.49, P = .006). Statistically significant negative correlations were found between BV/TV and trabecular spacing (Tb.Sp) (r = –0.65, P < .001), between BV/TV and trabecular pattern factor (Tb.Pf) (r = –0.7, P < .001), and between BV/TV and the structural model index (SMI) (r = –0.68, P < .001). However, no correlations between BV/TV and age or sex were found. Conclusion: Bone density was independent of the anatomical location, assessed by micro-CT in the pristine nonatrophic maxillary bone. Studies with a larger sample size and different population should be conducted to validate the findings of the current project. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to conduct a systematic review and meta-analysis to evaluate the influence of cantilevers upon implant-supported fixed partial dentures on marginal bone loss (MBL) and prosthetic-related complications. Materials and Methods: An electronic literature search was conducted in the PubMed database by two reviewers (LTM and AM) for articles written in English from June 2003 to January 2013 that were prospective human clinical trials with the clear purpose of appraising the effect of implant-supported fixed partial prostheses on peri-implant bone level and prosthetic complications. Data from the selected studies were extracted to carry out the statistical analysis. Results: Following the method described earlier, from initial research of 643 studies, 4 human clinical studies met the inclusion criteria and provided enough data to include them in the present meta-analysis. For the overall data, the pooled weighted mean (WM) of the MBL was 0.72 mm (range, 0.49 to 1.10 mm), with a 95% confidence interval (CI) of 0.36 to 1.08 mm. For the chi-square test, P = .60, representing a low heterogeneity among studies. MBL around implant-supported restorations with and without cantilevers was not found to be significant between both groups. The weighted mean difference (WMD) was 0.10 mm (favoring the noncantilever group), with a 95% CI = −0.18 to 0.39 mm (P = .47). For the chi-square test, P = .97, also indicating a low degree of heterogeneity between the studies. Conclusion: The dearth of scientific evidence in this matter does not permit clear conclusions to be drawn. However, within the limitations, marginal bone loss does not seem to be influenced by the presence of cantilever extensions. Moreover, minor technical complications were found when a cantilever was present when compared to the control groups. [ABSTRACT FROM AUTHOR]

Although some risk factors of peri-implant disease are well defined, the lack of efficient and predictable approaches to treat peri-implantitis has created difficulty in the management of those complications. The aim of this review was to evaluate the reliability of the diagnosis methods and to provide a set of guidelines to treat peri-implant diseases. A search of PubMed and a hand search of articles related to peri-implant diseases were conducted up to August 2013. A summary of the current methods for the diagnosis of peri-implantitis, its potential risk factors, and a flow chart to guide the clinical management of these conditions are presented. [ABSTRACT FROM AUTHOR]

The aim of this clinical case series was to evaluate buccal bone thickness using cone beam computed tomography and to demonstrate optimal clinical outcomes for implants placed into extraction sockets in the anterior maxilla with a thin biotype, by placing a graft of mineralized and demineralized human bone allograft into the buccal gap. The preliminary outcomes showed good preservation of soft and hard tissue architecture after 1 year in function. In particular, in eight patients, this allograft mixture appeared to minimize the amount of buccal contour change in the extraction site ridge with a thin buccal plate. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to test the sensitivity of the resonance frequency analysis for detecting early implant failure. Materials and Methods: In all, 3,786 implants placed from June 2007 to January 2013 were retrospectively evaluated. A total of 20 implants (in 20 patients) placed in pristine bone were found to have failed before loading. The implant stability quotient (ISQ) values were extracted from these 20 implants at baseline (immediate) and 4 months after placement (delayed). Simple linear regression, logistic regression, and two-way contingency tables were used to test for the relationships between ISQ values and early implant failure. Results: Immediate ISQ values were significantly related to failure (odds ratio [OR] = 4.27). Furthermore, the results of the second regression showed a significant relationship between ISQ at delayed measurement and implant failure (OR = 9.20). For immediate ISQ, it seems that the 73.7% correct classifications were obtained at the cost of an incorrect classification of 55% of the implant failures. However, for the delayed ISQ, 86.2% correct classifications were obtained at the cost of assuming that all implants will survive. Conclusion: The present study showed that ISQ values are not reliable in predicting early implant failure. In addition, the real cutoff ISQ value to differentiate between success and early implant failure remains to be determined. [ABSTRACT FROM AUTHOR]

Purpose: The evidence pertaining to the contribution of the sinus membrane to new bone formation following maxillary sinus augmentation procedures is equivocal. The purpose of this study was to analyse the evidence currently available on the osteogenic capacity of the sinus membrane following maxillary sinus augmentation procedures, and the effect of local delivery of recombinant human bone morphogenic proteins (rhBMPs) on the bone-forming potential of the sinus membrane. Materials and methods: An electronic search was conducted using six different databases to identify controlled trials, prospective and retrospective cohort studies, case series and case reports, as well as preclinical (animal) studies reporting on new bone formation in close proximity with the sinus membrane after maxillary sinus augmentation procedures, assessed through histological and/or histomorphometrical evaluation, on the basis of pre-established eligibility criteria. Results: No clinical studies were identified. Twenty-six preclinical studies were included in the review. Nine of them supported the osteogenic potential of the sinus membrane, while eight reported no evidence of osteogenicity from the sinus membrane. The nine remaining studies reported on the local effect of rhBMPs. The majority of these nine studies reported enhanced new bone formation in the sinus membrane region. Conclusions: The sinus membrane contains pluripotent mesenchymal cells with the capacity to differentiate and participate in the process of new bone formation. However, the findings from the studies selected in this systematic review do not consistently support that the sinus membrane significantly contributes to new bone formation following maxillary sinus augmentation procedures. [ABSTRACT FROM AUTHOR]

Purpose: The primary aim of this systematic review was to compare the amount of marginal bone loss around tilted and straight implants. As the secondary aim, the incidence of biomechanic complications was compared. Materials and Methods: An electronic literature search from five databases, for the years 2000 to 2011, and a hand search in implant-related journals were conducted. Clinical human studies in the English language that had reported marginal bone loss in tilted and straight implants at 12-months followup or longer were included. Mean marginal bone loss and the number of implants that were available for analysis were extracted from original articles for meta-analyses. Results: Eight (six prospective and two retrospective) studies were included. One-year data were available in seven articles, which included 1,015 (451 tilted) implants. Three articles provided 3- to 5-year data from 302 (164 tilted) implants. No significant difference in weighted mean marginal bone loss was found between the tilted and straight implants in the short and medium terms. Three articles reported the incidence of biomechanic complications. There was not enough information to make a comparison. Conclusions: This meta-analysis failed to support the hypothesis that tilted implants that were splinted for the support of fixed prostheses had more marginal bone loss. Additionally, there was not enough evidence to claim a higher incidence of biomechanic complications in tilted implants. However, due to the nature of the study design of the included articles, caution should be exercised when interpreting the results of this review. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the influence that lateral window dimensions may have on maxillary sinus augmentation outcomes. Materials and Methods: Patients requiring maxillary sinus augmentation by a lateral window approach and delayed implant placement were recruited in this study. Approximate window dimensions (AWD) were calculated in mm2 at the time of the surgical intervention. In all cases, a mixture of cortical and cancellous allograft particles was used as the sole grafting material. Patients were followed for 6 months. At the time of implant placement, bone core biopsies were harvested. Transversal circular samples were histomorphometrically analyzed. Proportions of vital bone (VB), remaining allograft particles (RA), and nonmineralized tissue (NMT) were quantified. Analysis of correlation of AWD with %VB, %RA, and %NMT was performed using a statistical model. Results: A total of 24 maxillary sinus augmentation procedures were performed in 21 patients. One patient developed an infection after grafting and was excluded. Histomorphometric analysis showed that mean %VB was 21.69% ± 16.30%, %RA was 23.51% ± 16.33%, and %NMT was 55.08% ± 8.52%. A strong negative correlation was observed between AWD and %VB (r = -0.621; P = .0007), a marked positive correlation was found between AWD and %RA (r = 0.565; P = .002), and a minimal positive correlation, without statistical significance, was found between AWD and %NMT (r = 0.076; P = .365). Conclusions: The results of this study suggest that AWD may have an important influence on the maturation and consolidation of a mixture of cortical and cancellous allograft in the maxillary sinus. [ABSTRACT FROM AUTHOR]

Objective: To evaluate, in vitro, the antimicrobial effect of ozone gas on strains of reference mutans streptococci and strains isolated from children at a high risk of developing caries. Method and Materials: A series of dilutions was obtained from a total of 41 strains, and the effect of ozone was determined for applications of 10, 20, and 40 seconds, as well as a control, in terms of the reduction of viable bacteria. Results: Ozone application for 10 and 20 seconds produced a significant reduction in the number of bacteria, inversely proportional to the bacterial concentration. When exposure lasted 40 seconds, no viable bacteria were obtained. Conclusions: Both time of application and initial bacterial concentration bear an influence on the antimicrobial effect of ozone on mutans streptococci. [ABSTRACT FROM AUTHOR]

Dental invagination or dens in dente is a rare malformation with a widely varied morphology. Radiographically, the affected tooth shows an infolding of the enamel and dentin that can extend to within the pulp cavity and the root and sometimes to the root apex. It can occur in both primary and permanent teeth, and its prevalence is reported to be 1.7% to 10%. The dental anomalies observed in association with dental invagination include taurodontia, microdontia, supernumerary teeth, gemination, and dentinogenesis imperfecta. This article presents a clinical case in which a radiographic finding could be compatible with the presence of a nasopalatine or globulomaxillary cyst and a dens in dente. It was decided to extract the invaginted tooth, and by 15 days postextraction, the radiolucid area had completely disappeared The complex surgery that would have been required lo remove the patient's supposed cyst was thus avoided. Clinical and radiographic examination is suggested before making further decisions that could complicate treatment when a lesion is associated with other dental anomalies. (Quintessence Int 2003;34:509-514) [ABSTRACT FROM AUTHOR]

The article focuses on research into risk factors for peri-implantitis and preventive measures. It states that pathogenic bacteria and fungi could indirectly cause peri-implantitis with an inflammatory process similar to those identified in chronic periodontitis and talks about processes that can transform oral microorganisms and produce dysbiosis. It comments on different messenger RNA profiles between peri-implantitis and periodontitis, and the use of treatment planning in preventive medicine.